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Workers’ Compensation Forms

Workers’ Compensation provides eligible workers who are either injured or who become ill during the course of employment with medical coverage and, if applicable, disability coverage. The program is legislated by State law. The City’s self-funded Workers’ Compensation program is administered by LWP Claim Solutions, Inc. (LWP).

  1. Workers' Comp Claim Form (DWC-1) Turn in to HR within 24hrs 
  2. Employers Report of Occupational Injury or Illness (Form 5020) Turn in to HR within 24hrs


LWP Claims Solution, Inc.

Address: PO Box 349016 Sacramento, CA 95834-9016

T: (800) 565-5694
Fax: (408) 725-0395


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